Overview of carpal fractures
- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
Upper extremity fractures are among the most common of limb injuries; carpal fractures account for 18 percent of hand fractures and 6 percent of all fractures . Fractures to bones of the proximal carpal row are most frequent. Scaphoid fractures are by far the most common of the carpal fractures, and account for 10 percent of all hand fractures and 60 to 70 percent of all carpal fractures . The incidence of fracture of the remaining bones is small, being on the order of 0.2 to 5 percent. In general, carpal fractures occur from either direct or indirect trauma. (See "Scaphoid fractures".)
Splinting is used in the initial immobilization of carpal fractures. A detailed description of the techniques for applying splints is presented separately. (See "Splinting of musculoskeletal injuries".)
This topic provides an overview of basic carpal anatomy, mechanisms of injury, general principals of examination and imaging, and the initial care of adults with carpal fractures. More detailed discussions of common and important wrist injuries are presented separately. (See "Evaluation of the adult with subacute or chronic wrist pain" and "Distal radius fractures in adults" and "Scaphoid fractures" and "Lunate fractures".)
CLASSIFICATION AND CLINICAL PRESENTATION
Carpal fractures are classified primarily by the anatomic location of the fracture (see 'Anatomy' below) and secondarily based upon the features of the injury, including associated displacement, dislocation, and the number of fragments produced by the fracture (comminuted versus noncomminuted). Isolated fractures through the distal radius or ulna, although described in lay terms as "wrist fractures," do not involve the carpal bones. (See "General principles of fracture management: Bone healing and fracture description".)
Brief description of fractures — Issues related to fractures of the eight carpal bones (image 1) are discussed separately in the appropriate topic reviews that are listed below:
- Dobyns JH, Beckenbaugh RD, Bryan RS, et al. Fractures of the hand and wrist. In: Hand Surgery, 3rd, Flynn JE (Ed), Williams & Wilkins, 1982.
- Geissler WB, Slade JF. Fractures of the carpal bones. In: Green's Operative Hand Surgery, 6th ed, Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH (Eds), Churchill Livingstone, 2011.
- Ingari JV. Wrist and hand. In: DeLee and Drez's Orthopedic Sports Medicine Principles and Practice, 3rd ed, DeLee JC, Drez D, Miller MD. (Eds), Saunders Elsevier, Philadelphia 2010.
- Gaebler C, McQueen MM. Carpus fractures and dislocations. In: Rockwood and Green's Fractures in Adults, 7th ed, Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P (Eds), Lippincott, Williams, & Wilkins, Philadelphia 2010.
- Eiff MP, Petering RC. Carpal fractures. In: Fracture Management for Primary Care, 3rd ed, Eiff MP, Hatch RL (Eds), Saunders, Philadelphia 2013.
- CLASSIFICATION AND CLINICAL PRESENTATION
- Brief description of fractures
- Location of pain
- Mechanism of injury
- - Axial loading
- - Wrist hyperextension
- - Wrist hyperflexion
- - Deviation, traction, or rotation
- - Direct blow to the palmar surface
- - Combinations of forces
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR SURGICAL REFERRAL
- ADDITIONAL RESOURCES
- INFORMATION FOR PATIENTS